Medical Eligibility Specialist


Top Job

Located in Unincorporated, WV

Salary: $15.00


Express Employment has the CAREER you are looking for! We are currently recruiting Eligibility Specialists to work with a well-established medical research company located in the Morgantown area. This position will offer compensation of up to $15.00 hourly, hours ranging Monday – Friday 8:00am – 8:00pm, excellent medical benefits, employee friendly PTO and vacation programs, and a 5% profit sharing.

Provide the highest quality of customer service to patients and client representatives, which entail acquiring in depth knowledge of client and marketing requirements. Complete verification of Benefits and Eligibility for all referrals from patients, medical doctor’s office (MDOs), health plans and pharmaceutical manufacturers. Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting on therapy.

Specific Job Duties

  • Review incoming referrals for completeness of and confirm FDA requirements are met as applicable. These are typically received via facsimile, Web portal or client partner download.
  • Answer all Incoming calls quickly and efficiently, evaluate their need and respond or disseminate call to appropriate member of team.
  • Aid with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues from patients, MDOs, payers and Sales Representatives
  • May provide billing and coding information related to specific product(s)
  • Conduct general payer research
  • Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting therapy.
  • Participate in call center activities, triage, and respond to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies.
  • May serve as single point of contact for an assigned group of prescribers.
  • Effectively manage and work though action item list to ensure it is current and tasks are completed in a timely fashion.
  • Maintain accurate and complete documentation of all inquiries to continuously improve the customer service process and reduce potential legal concerns.
  • Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited.

Desired Skills And Qualifications

  • High School diploma or equivalent
  • 3-5 years’ experience in a customer service setting preferably in a call center environment; Previous experience in the PBM and or Healthcare Industry preferred
  • Computer proficiency in MS Office applications, with database experience preferred
  • Health insurance claims or patient accounting experience preferred
  • Knowledge of third-party billing, coding, medical terminology, prior authorizations and appeals preferred
  • Detail oriented with good analytical skills
  • Ability to manage multiple priorities and meet deadlines
  • Excellent written and verbal communication skills, demonstrated ability to communicate with others at all levels
  • Excellent customer skills-patience to explain details and processes repeatedly, excellent phone presentation skills
  • Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision
  • Advance problem-solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
  • Ability to work a flexible schedule


This client is able to support work from home temporarily due to COVID 19 however once the situation resolves it will require reporting to the Morgantown office daily.


If you are interested in this role, please call (304) 381-4466 or Email resume to


Express Employment Professionals is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. 

Express Office: Morgantown
3000 Coombs Farm Drive
Suite 106
Morgantown, WV 26508
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